Ding Li-Shan, Liang Hao, Zheng Ming, Shen Meng, Li Zhao-Jun, Chen Qing-Liang
Department of Hemato-Oncology, The First Affillated Hospital of Henan University of Chinese Medicine Zhengzhou 450099, Henan, China.
Department of Radioactive Intervention, Henan No. 3 Provincial People's Hospital Zhengzhou 450006, Henan, China.
Am J Transl Res. 2024 Nov 15;16(11):6846-6851. doi: 10.62347/YTDM4495. eCollection 2024.
ECMO is an advanced technology for extracorporeal respiratory and circulatory support. It involves the extraction of venous blood from the patient's body, which is subsequently oxygenated within an oxygenator (or membrane lung). This oxygen-rich blood is reinfused either into veins or arteries, rapidly compensating for impaired lung and heart functionalities. ECMO mirrors the essential processes of cardiac output in facilitating tissue perfusion and gas exchange, thereby expanding the therapeutic window for critically ill patients with acute circulatory insufficiency, and enabling restoration of cardiopulmonary function. We report a 55-year-old woman with no prior significant health issues who suddenly experienced headache accompanied by nausea and vomiting while resting at home. A small amount of gastric content was vomited, and no specific treatment was administered. Two hours later, she was found unconscious on the bathroom floor, with her mouth and nose filled with vomit, loss of consciousness, dyspnea, and urinary incontinence. A cranial CT scan revealed "subarachnoid hemorrhage with left frontal lobe cerebral hemorrhage extending into the ventricular system". Despite intervention, the peripheral blood oxygen saturation rapidly dropped to 70%. The electrocardiogram showed sinus rhythm with abnormal ST-T changes. Subsequently, the ECMO (Extracorporeal Membrane Oxygenation) specialized treatment team performed a bedside ultrasound-guided Veno-Arterial (V-A) ECMO implantation procedure for the patient. Given that cranial CTA imaging demonstrated a 5 mm × 5 mm × 7 mm wide-necked aneurysm with an irregular shape at the M1 bifurcation of the left middle cerebral artery, this aneurysm was deemed the culprit lesion responsible for the rupture and bleeding. Consequently, an ECMO-supported cerebral aneurysm stent-assisted embolization procedure was carried out. Following anticoagulation, anti-infection therapy, continuous cerebrospinal fluid drainage, nimodipine infusion to prevent cerebral vasospasm, and traditional Chinese medicine rehabilitation treatment, the patient regained spontaneous respiration on the 5th day after surgery. She was successfully discharged from the hospital on the 26th day post-surgery. Thus, ECMO-supported stent-assisted embolization treatment modality is feasible for patients with ruptured cerebral aneurysms and subarachnoid hemorrhage. However, the value of ECMO in recovering consciousness among patients with ruptured cerebral aneurysm and subarachnoid hemorrhage-induced coma requires further validation through a larger number of cases.
体外膜肺氧合（ECMO）是一种用于体外呼吸和循环支持的先进技术。它涉及从患者体内抽取静脉血，随后在氧合器（或膜肺）中进行氧合。这种富含氧气的血液再注入静脉或动脉，迅速补偿受损的肺和心脏功能。ECMO在促进组织灌注和气体交换方面模拟了心输出量的基本过程，从而扩大了急性循环功能不全重症患者的治疗窗口，并使心肺功能得以恢复。我们报告了一名55岁女性，既往无重大健康问题，在家休息时突然出现头痛伴恶心、呕吐。呕吐少量胃内容物，未给予特殊治疗。两小时后，她被发现昏迷在浴室地板上，口鼻充满呕吐物，意识丧失，呼吸困难，伴有尿失禁。头颅CT扫描显示“蛛网膜下腔出血伴左额叶脑出血破入脑室系统”。尽管进行了干预，外周血氧饱和度仍迅速降至70%。心电图显示窦性心律，ST-T改变异常。随后，ECMO（体外膜肺氧合）专业治疗团队为患者进行了床旁超声引导下的静脉-动脉（V-A）ECMO植入手术。鉴于头颅CTA成像显示在左大脑中动脉M1分叉处有一个5毫米×5毫米×7毫米的不规则宽颈动脉瘤，该动脉瘤被认为是破裂出血的罪魁祸首。因此，进行了ECMO支持下的脑动脉瘤支架辅助栓塞手术。经过抗凝、抗感染治疗、持续脑脊液引流、静脉滴注尼莫地平预防脑血管痉挛以及中医康复治疗后，患者在术后第5天恢复自主呼吸。她在术后第26天成功出院。因此，ECMO支持下的支架辅助栓塞治疗方式对于破裂脑动脉瘤和蛛网膜下腔出血患者是可行的。然而，ECMO在破裂脑动脉瘤和蛛网膜下腔出血所致昏迷患者意识恢复方面的价值需要通过更多病例进一步验证。
